单钳道内镜跨越式荷包缝合法封闭医源性消化道黏膜缺损42例分析

唐静; 卢丹萍; 况晶; 杨丹; 吴涛; 杨美华; 刘爱民

doi:10.16016/j.1000-5404.201612029

您当前的位置：

首页 >

文章列表页 >

单钳道内镜跨越式荷包缝合法封闭医源性消化道黏膜缺损42例分析

临床医学 | 更新时间：2026-01-09

- 单钳道内镜跨越式荷包缝合法封闭医源性消化道黏膜缺损42例分析
- Single-channel endoscopic forceps leaping pouch suture for repairing iatrogenic digestive tract mucosa defects: report of 42 cases
- 第三军医大学学报 2017年39卷第14期页码：1493-1497
- 作者机构：
  
  408000 重庆，重庆市涪陵中心医院消化科
- 作者简介：
  
  [ 刘爱民, E-mail:512667798@qq.com LIU Aimin, E-mail: 512667798@qq.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201612029
  中图分类号： R181.32; R573; R573.1
- 收稿：2016-12-05，
  
  修回：2017-02-10，
  
  纸质出版：2017-07-30
- 稿件说明：
移动端阅览
唐静, 卢丹萍, 况晶, 等. 单钳道内镜跨越式荷包缝合法封闭医源性消化道黏膜缺损42例分析[J]. 第三军医大学学报, 2017,39(14):1493-1497.

Jing TANG, Danping LU, Jing KUANG, et al. Single-channel endoscopic forceps leaping pouch suture for repairing iatrogenic digestive tract mucosa defects: report of 42 cases[J]. Journal of Third Military Medical University, 2017, 39(14): 1493-1497.
唐静, 卢丹萍, 况晶, 等. 单钳道内镜跨越式荷包缝合法封闭医源性消化道黏膜缺损42例分析[J]. 第三军医大学学报, 2017,39(14):1493-1497. DOI： 10.16016/j.1000-5404.201612029.

Jing TANG, Danping LU, Jing KUANG, et al. Single-channel endoscopic forceps leaping pouch suture for repairing iatrogenic digestive tract mucosa defects: report of 42 cases[J]. Journal of Third Military Medical University, 2017, 39(14): 1493-1497. DOI： 10.16016/j.1000-5404.201612029.

摘要

目的

探讨单钳道内镜跨越式荷包缝合法在封闭医源性胃肠黏膜缺损中的临床价值。

方法

回顾性分析2015年4月至2016年8月我科消化内镜中心对胃肠道病变行内镜黏膜下剥离术(endoscopic submucosal dissection，ESD)形成较大创面的患者资料，其中42例采用我科自创的单钳道内镜跨越式荷包缝合(研究组)，余21例创面旷置(对照组)，比较两组术后并发症发生情况及创面愈合情况，评估单钳道内镜跨越式荷包缝合法的可行性、安全性和疗效。

结果

研究组ESD术后创面直径(1.4±0.8) cm，对照组创面直径(1.2±1.0) cm，差异无统计学意义(

0.05)。研究组单钳道内镜跨越式荷包缝合创面，每个患者平均使用金属夹4~6个，尼龙绳1~2个，创面缝合满意，成功率100%，术后5例

(5/42，11.9%)出现一过性发热，4例(4/42，9.5%)出现腹痛、腹胀；对照组中4例(4/21，19.0%)出现发热，6例(6/21，28.6%)出现腹痛、腹胀，2例(2/21，9.5%)术后创面出血，两组差异有统计学意义(

0.05)；研究组住院时间(4.52±1.27) d，对照组住院时间(6.94±1.53) d，差异有统计学意义(

0.05)。术后随访，研究组1个月后创面均愈合良好，可见疤痕形成，有6例患者金属夹及尼龙绳未脱落，2个月后复查内镜，创面光滑，愈合良好，仅1例患者金属夹及尼龙绳未脱落；对照组1个月后随访，3例患者创面形成巨大溃疡，2个月后复查内镜，其中1例患者溃疡面愈合较差。

结论

单钳道内镜跨越式荷包缝合法修补ESD术后较大创面术后并发症率低、住院时间短、创面愈合好；该法安全而有效，可广泛应用于临床。

Abstract

Objective

To evaluate the efficacy of single-channel endoscopic forceps leaping pouch suture for repairing iatrogenic defect in the gastrointestinal mucosa.

Methods

Between April

2015 and August

2016

63 patients underwent endoscopic submucosal dissection (ESD) in our Digestive Endoscopy Center

which caused extensive mucosal defects in the gastrointestinal tract. The wounds were repaired with single-channel endoscopic leaping pouch suture in 42 patients (treatment group) and left exposed without suture in 21 patients (control group). The postoperative complications and wound healing were compared between the 2 groups to assess the feasibility

safety and efficacy of single-channel endoscopic leaping pouch suture.

Results

The mean diameter of the mucosal wounds were comparable between the treatment and control group before operation (1.4±0.8

1.2±1.0 cm

0.05). In the treatment group

single-channel endoscopic leaping pouch suture used 4 to 6 metal clips and 1 or 2 nylon ropes in each operation

and a 100% success rate of wound closure was achieved after the operation. Five (11.9%) patients in the treatment group experienced transient fever after the operation and 4 (9.5%) reported abdominal pain and distension; in the control group

4 (19%) patients experienced fever

6 (28.6%) reported abdominal pain and distension

and 2 (9.5%) had postoperative wound bl

eeding

showing significant differences in the postoperative complications between the two groups (

0.05). The hospitalization time was significantly shorter in the treatment group than in the control group (4.52±1.27

6.94±1.53 d

0.05). At 1 month after the operation

good wound healing and scar formation were observed in the treatment group

and the metal clips and nylon rope did not fall off in 6 patients; at 2 months after the operation

endoscopic examination revealed good wound healing with smooth surface in the treatment group

and the metal clips and nylon rope remained in only 1 case. In the control group

follow-up of the patients at 1 month showed massive ulcer in the wound in 6 patients

and endoscopy at 2 months still revealed poor healing of the ulcer in 1 patient.

Conclusion

Single clamp endoscopy leaping pouch suture is safe and effective for repairing extensive gastrointestinal mucosal defects due to ESD and is associated with a low complication rate

a shorter hospital stay

and good wound healing.

关键词

Keywords

references

郭花, 汤姗, 王晓伟, 等.消化道黏膜下肿物内镜下切除及其并发症防治[J].胃肠病学和肝病学杂志, 2014, 23(10): 1220-1223. DOI: 10.3969/j.issn.1006-5709.2014.10. 032.

GUO H, TANG S, WANG X W, et al.Endoscopic resection of gastrointestinal submucosal tumor and the prevention of complications [J].Chin J Gastroenterol Hepatol, 2014, 23(10): 1220-1223. DOI: 10.3969/j.issn.1006-5709.2014.10.032.

李伏超, 史冬涛, 周晓俊, 等.内镜与腹腔镜切除胃间质瘤的临床对比研究[J].中华消化内镜杂志, 2014, 31(2): 69-71. DOI: 10.3760/cma.j.issn.1007-5232.2014.02.003.

LI F C, SHI D T, ZHOU X J, et al.Comparison between endoscopy and laparoscopy in resection of gastric stromal tumor [J].Chin J Dig Endosc, 2014, 31(2): 69-71. DOI: 10.3760/cma.j.issn.1007-5232.2014.02.003.

CHOI C W, KIM H W, KANG D H, et al. Clinical outcomes of second-look endoscopy after gastric endoscopic submucosal dissection: predictive factors with high risks of bleeding[J]. Surg Endosc, 2014, 28(7): 2213-2220. DOI: 10.1007/s00464-014-3457-2.

OJIMA T, TAKIFUJI K, NAKAMURA M, et al. Complications of endoscopic submucosal dissection for gastric noninvasive neoplasia: an analysis of 647 lesions[J]. Surg Laparosc Endosc Percutan Tech, 2014, 24(4): 370-374. DOI: 10.1097/SLE.0b013e318290132e.

LIM S M, PARK J C, LEE H, et al. Impact of cumulative time on the clinical outcomes of endoscopic submucosal dissection in gastric neoplasm[J]. Surg Endosc, 2013, 27(4): 1397-1403. DOI: 10.1007/s00464-012-2643-3.

BIAłEK A, WIECHOWSKA-KOZłOWSKA A, PERTKIEWICZ J, et al. Endoscopic submucosal dissection for the treatment of neoplastic lesions in the gastrointestinal tract[J]. World J Gastroenterol, 2013, 19(12): 1953-1961. DOI: 10.3748/wjg.v19.i12.1953.

RYU H Y, KIM J W, KIM H S, et al. Second-look endoscopy is not associated with better clinical outcomes after gastric endoscopic submucosal dissection: a prospective, randomized, clinical trial analyzed on an as-treated basis[J]. Gastrointest Endosc, 2013, 78(2): 285-294. DOI: 10.1016/j.gie.2013.02.008.

AHMAD N A, KOCHMAN M L, LONG W B, et al. Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases[J]. Gastrointest Endosc, 2002, 55(3): 390-396. DOI: 10.1067/mge.2002.121881.

VON RENTELN D, SCHMIDT A, VASSILIOU M C, et al. Endoscopic full-thickness resection and defect closure in the colon[J]. Gastrointest Endosc, 2010, 71(7): 1267-1273. DOI: 10.1016/j.gie.2009.12.056.

VOERMANS R P, VERGOUWE F, BREEDVELD P, et al. Comparison of endoscopic closure modalities for standardized colonic perforations in a porcine colon model[J]. Endoscopy, 2011, 43(3): 217-222. DOI: 10.1055/s-0030-1256072.

FEITOZA A B, GOSTOUT C J, RAJAN E, et al. Understanding endoluminal gastroplications: a histopathologic analysis of intraluminal suture plications[J]. Gastrointest Endosc, 2003, 57(7): 868-876. DOI: 10.1067/mge.2003.251.

YOSHIKANE H, HIDANO H, SAKAKIBARA A, et al. Feasibility study on endoscopic suture with the combination of a distal attachment and a rotatable clip for complications of endoscopic resection in the large intestine[J]. Endoscopy, 2000, 32(6): 477-480. DOI: 10.1055/s-2000-648.

ZHANG Y, WANG X, XIONG G, et al. Complete defect closure of gastric submucosal tumors with purse-string sutures[J]. Surg Endosc, 2014, 28(6): 1844-1851. DOI: 10.1007/s00464-013-3404-7.

冯春, 张旭, 房玉亮, 等.内镜治疗术中尼龙绳的应用价值探讨[J].中华临床医师杂志, 2014, 8(3): 452-455. DOI: 10.3877/cma.j.issn.1674-0785.2014.03.021.

FENG C, ZHANG X, FANG Y L, et al.The clinical value of nylon ligation during endoscopic therapy [J]. Chin J Clinician, 2014, 8(3): 452-455. DOI: 10.3877/cma.j.issn.1674-0785.2014.03.021.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

内镜下经气管入路甲状腺切除术的应用解剖及临床意义